=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255741138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAUN FIRSTER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2014
-----------------------------------------------------
Last Update Date | 04/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 STATE ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16550-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-453-3900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3998 FAIR RIDGE DR STE 300
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22033-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-293-9590
-----------------------------------------------------
Fax | 703-766-9725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN518981L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------